Practice Tips #98: Is Your Schedule Full of Bullet Holes? (Guest Post)

Why Consistency and Communication are the Keys to Compliance

There’s one universal challenge among dental practices across the country. It does not discriminate based on region, demographics, insurance affiliation, or size of the practice. Schedules lack consistency and communication. No-shows are plaguing doctors everywhere, turning productive days into unprofitable disappointments. One study estimated that no-shows cost the health care system an estimated $150 billion dollars a year.

Why Patients Cancel

There are a number of reasons that patients cancel: inconvenience, money, fear, or a lack of motivation, understanding, or trust with their dental provider. If you’re over experiencing the emotional rollercoaster of a bombed out schedule, this practice tip is for you.

I’m going to tell you a bit of bad news first: fifty percent of the problem belongs to you and fifty percent belongs to social psychology. But the good news is, there are things you can do to increase appointment compliance, using principles of social psychology in your favor! It all starts with human nature.

Reactance is the motive to protect or restore a sense of rebellious freedom. This means it’s totally normal for your patients to want to assert their autonomy when things feel out of control. Just imagine, they can’t control what’s going on in their mouths, they can’t control how much it costs, but the one thing they can control: their compliance. And that includes rebelling against the appointments that are beneficial for them.

It’s also human nature for people to get away with whatever they can get away with; testing limits stems from an innate desire to protect one’s freedom in the presence of a perceived authority. We can respond to this power struggle by exercising the powerful influences of social norms to restore a spirit of cooperation when it comes to our patients, their appointments, and their oral health.

5 Really Effective Ways to Motivate Your Patients to Keep Appointments

1. Reciprocity: If I give something to you, you feel obliged to return the favor.

  • Patients will be more likely to respect your time if you respect theirs.
  • If you charge a cancellation fee, what do they get if you cancel or run late for them?

2. Commitment: People feel an obligation to fulfill their social commitments. This maintains their positive self-view and reduces cognitive dissonance, a perceived threat to their identity.

  • Will you call me 2 days in advance if you can’t make it?
  • We are no longer charging a cancellation fee, instead we are asking our patients not to reserve an appointment unless they are sure they can make it. Would you still like to reserve this time?

3. Worthiness: People want to feel respected by others whose opinions they value.

  • Patients will be less likely to cancel if a provider does their confirmation call.
  • When a provider praises their faithful home care or on-time recall, it reinforces the behavior.

4. Concession: If a patient says no to you once or if you make a smaller request they are way more likely to say yes to the second request. But you have to make the request.

  • Can you come another time later today? What about tomorrow?

5. Participative decision making: Permitting groups to establish their own guidelines increases compliance and decreases resentment.

  • Allowing patients to choose what penalty works for them will be more effective (i.e. picking a charity and an amount to donate if they cancel).

One Not So Effective Patient Strategy

Punishing Patients: By lecturing or taking an inflexible stance on your “policy.” This is the least effective in compliance, because the punitive approach makes a patient feel shamed, disconnecting them emotionally from you.

  • When you show frustration at a patient who is cancelling or try to dominate them with the “policy” they believe you don’t like them anymore, which makes them less likely to like you.
  • Instead be flexible with them, empathetic to their excuse, and let them know what you can do to help them avoid the fee.

An effective appointment policy is one that’s consistent and communicated well.

Let’s perform a diagnostic on the consistency and communication in your practice appointment policy. A is for "Always," N is for "Never," and S is for "Sometimes."

Consistency - A recipe for results.

  1. Clear, written, signed policy A/N/S
  2. Clear definitions of excusable and non excusable reasons for cancelling A/N/S
  3. Patients informed of policy at orientation A/N/S
  4. Patients informed of policy every time you schedule an appointment A/N/S
  5. Caring, consistent 1st time response to cancelling A/N/S
  6. Caring, consistent 2nd time response to cancelling A/N/S
  7. Caring, consistent policy for repeat offenders A/N/S

Communication - It’s what you say and how you say it.

  1. Confirmation Systems: At least one step involving a human, first contact no less than 1 week out A/N/S
  2. Dental Language: Do we call all procedures the same name? A/N/S
  3. Urgency: Do we all use the same level of urgency and concern when discussing treatment? A/N/S
  4. Why: Do we document a reason for patients to come back and remind them of it? A/N/S
  5. Tone: What does our tone say? Helpful, empathetic and non judgmental? A/N/S
  6. Questions: If a patient wants to delay or cancel do we ask why and try to help? A/N/S
  7. Appreciation: Do we thank patients who come on time, and praise patients who come faithfully to their appointments? A/N/S
  8. Commitment: Do we ask patients to give a verbal commitment that they will call us if their plans change? A/N/S

The more patients feel you’re on their side, the less likely their desire to rebel will kick in. This involves using a tone of helpfulness with patients if they have to unexpectedly cancel, mutual respect for each other’s time, and consistency in the way we communicate the importance of their appointments. When benefits and consequences of treatment are clear, communication is consistent, frequent, and kind, we can effectively create a foundation of trust and understanding. Consistency and communication helps to help fill our schedules while also serving our patients.

Written by Holly Mitchell, Practice Management Coach

For more information on Social Psychology and Human Influence, check out Dr. Robert Cialdini’s Influence: Science and Practice. If you’d like a free copy of the Effective Phone Script to Reduce Cancellations, email

We also wrote a blog post on how to increase your dental practice profits. Read more here.


Please note, comments must be approved before they are published